Implementation of SAMHSA-funded Offender Re-Entry Programs Addressing Substance Use and Co-occurring Disorders among Justice Involved Latino Adults

Objectives: Racial and ethnic minorities have high rates of incarceration and persons entering the criminal justice system have disproportionate rates of mental health and substance use disorders Justice involved individuals do not receive adequate treatment resulting in greater risk of recidivism and relapse. This study examines the facilitators and barriers to implementing a SAMHSA-funded Offender Re-Entry Program (ORP) to better understand the factors that influence successful implementation of integrated bilingual/bicultural treatment, recovery, and re-entry services for recently incarcerated adult Latino individuals with substance use and co-occurring behavioral health disorders. Methods: Structured interviews were conducted with leadership, direct staff, and non-direct staff involved in the development and implementation of the Rumbo a Casa ORP at Casa Esperanza, Inc. Using the Consolidated Framework for Implementation Research (CFIR), we investigated the domains and constructs that were critical to successful implementation. Interviews were analyzed using NVivo 11 software. Results: Qualitative analyses show that across all domains, inner setting, particularly the implementation climate of an organization, is reported most often as influencing (positively or negatively) the implementation of the program. Findings show that the current process structure and the characteristics of individuals are greatly impacting program implementation as reported by direct staff. These findings demonstrate that the process of implementation which includes planning, engaging, executing, reflecting and evaluating constructs is essential for the successful implementation an offender-reentry program. Dedicated leadership is necessary to enhance implementation of fundamental program activities using a Plan-Do-Study-Act (PDSA) quality improvement cycle. Conclusion: An established implementation research framework can identify key issues critical to the implementation and evaluation processes. This study provides a deepened understanding of components critical to the successful implementation of an ORP and adds to the limited implementation research knowledge on evidence-based care approaches for justice involved Latino adults

The Association Between Self-Reported Mental Health Status and Alcohol and Drug Abstinence 5 Years Post-Assessment for an Addiction Disorder in U.S. and Swedish Samples

This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally

Integrating addiction and mental health treatment within a national addiction treatment system : Using multiple statistical methods to analyze client and interviewer assessment of co-occurring mental health problems

AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data from the ASI Interviewer Severity Rating (ISR) score were used to develop a K-means cluster analysis with three client cluster profiles: Narcotics (n=4795); Alcohol (n=4380); and Alcohol and Psychiatric Problems (n=3658). Chi-square and one-way ANOVA analyses identified self-reported mental health problems for these clusters. RESULTS - 44% of clients had a history of using outpatient mental health treatment, 45% reported current mental health symptoms, and 19% reported significant mental health problems. Women were 1.6 times more likely to report significant mental health problems than men. Staff assessed that 74.8% of clients had current mental health problems and that 13.9% had significant mental health problems. Client and staff results were congruent in identifying that clients in the Alcohol profile were less likely (5%) to report having significant mental health problems compared to the other two profiles (30% each). CONCLUSIONS - About 19% of clients with SUDs reported significant mental health problems, need integrated addiction and mental health treatment, and these clients are clustered in two population groups. An additional 25% of the addiction treatment population report current mental health symptoms and have at some point used mental health treatment. This national level assessment of the extent and severity of co-occurring disorders can inform decisions made regarding policy shifts towards an integrated system and the needs of clients with co-occurring disorders

Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations

Abstract Background Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community. Methods We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method. Results Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels. Conclusions The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers’ understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state)